AbstractThere is little known about the incidence of cancer among sewage workers. In this paper we examine findings from a retrospective cohort study of 487 white male sewer authority workers employed between January 1950 and October 1979. Vital status was ascertained for 93% of the cohort yielding a total of 6,886 person years. Total mortality from all causes was comparable to that of the general white male U.S. population (Standardized Mortality Ratio [SMR] = 0.91, 95% Confidence Interval [CI]= 0.77‐1.07). The cohort was subdivided into those not exposed, and sewer workers who were exposed to sewage effluent, sludge, or wastewater containing chemicals including potential carcinogens. Among the nonexposed group, mortality from all causes was significantly low (SMR = 0.55, 95% CI = 0.33‐0.88). Among the exposed sewer workers, mortality from all causes was not significantly different from that of the general white male U.S. population (SMR = 1.00, 95% CI = 0.84‐1.19). Mortality from all cancers among exposed sewer workers was slightly higher than that of the general population (SMR = 1.19, 95% CI = 0.79‐1.7). Statistically significant elevated mortality ratios were seen for cancer of the larynx (SMR = 7.93, 95% CI = 1.59‐23.96), and cancer of the liver (SMR = 5.4, 95% CI = 1.10‐16.05). Careful study of the medical and occupational histories of these cases suggested that larynx cancer was possibly work‐related, while liver cancer was not. A group estimated to be the highest exposed, composed predominantly of operatives, had a higher directly adjusted death rate from all malignant neoplasms combined compared to all other workers (rate ratio = 1.64). These findings of increased risk of cancer among exposed sewage workers, especially operators, are based on small number of cases and should be interpreted with caution. Studies of larger cohorts are needed to clarify the risk of these cancers among s